Lead Coder – Risk Management

This is a fully remote position, open to applicants in Alabama, +32 more states.

📋 Description

• Serves as a resource and role model for team members, which includes training/orienting, providing daily work direction, and offering performance feedback.

• Assigns, monitors, and reviews the progress, quality, and accuracy of work, oversees productivity, ensures appropriate staffing levels, directs efforts, and provides guidance on more complex issues.

• Codes both routine and complex procedures and diagnoses, including surgical procedures performed in hospitals or surgery centers, following ICD, CPT, and HCPCS coding guidelines, procedures, and protocols for both government and commercial payers.

• Meets or surpasses departmental quality and production standards.

• Conducts informal quality reviews on a monthly basis, providing coding education to coding team members for accuracy improvement.

• May assist in educating/orienting providers regarding policy requirements set by federal and state government agencies.

• Abstracts documentation to select the correct ICD, CPT, and HCPCS codes according to standard coding guidelines, procedures, and protocols.

• Identifies, reports, and serves as a resource to help resolve billing compliance issues.

• Acts as a liaison between the business office, medical records, patient care, and/or coding department by providing feedback to caregivers and leadership.

• Responsible for managing denial claims and addressing patient inquiries.

• Serves as a resource for caregivers regarding pre-authorizations, referrals, and charge estimates prior to a patient's visit.

• Coordinates payer audit reviews and serves as a resource for coding-related audits.

• Participates in various departmental projects, including but not limited to researching new services, claim scrubbing, quality checks/assessing errors, and presenting demonstrations.

• Acts as the system/application administrator, ensuring the integrity of the system and identifying performance issues.

• Conducts calibration and troubleshooting procedures, escalating unresolved issues as necessary.

• Recommends modifications to existing policies and procedures to align with insurance payer requirements.

• Serves as a subject matter expert in your assigned specialty and actively participates in Coding meetings as a problem solver.

• Adheres to organizational and internal department policies and procedures to ensure efficient work processes.

• Possesses expertise in query guidelines and coding standards.

• Follows up and obtains clarification on inaccurate documentation as appropriate.

• Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals, and hospitals to assign diagnosis and procedure codes using ICD-10 CM/PCS, CPT, and HCPCS.

• Ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations, utilizing an EMR and/or Computer Assisted Coding software.

• Complies with the Standards of Ethical Coding established by the American Health Information Management Association and adheres to official coding guidelines.

• Exercises ethical judgment when assigning and sequencing codes for proper insurance reimbursement.

• Maintains patient record confidentiality.

• Reports any observed non-compliant practices to the coding leader or compliance officer.

• Meets productivity expectations to support discharged not final billed (DNFB).

• Assists in producing the annual edit review based on CPT, ICD, and HCPCS changes and assists in developing edits based on publications and society updates.

⛳️ Requirements

• Certification required: Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC) or American Health Information Management Association (AHIMA).

• Advanced training beyond high school, including completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience).

• Typically requires 7 years of experience in professional coding, which includes experience in revenue cycle processes and health information workflows or related healthcare leadership experience.

• Knowledgeable in researching coding-related topics and issues.

• Advanced proficiency in ICD, CPT, and HCPCS coding guidelines.

• In-depth knowledge of medical terminology, anatomy, and physiology.

• Excellent computer skills, including proficiency in Microsoft Office products, electronic mail, and experience with electronic coding systems or applications.

🏝️ Benefits

• Paid Time Off programs.

• Health and welfare benefits including medical, dental, vision, life, and Short- and Long-Term Disability.

• Flexible Spending Accounts for eligible healthcare and dependent care expenses.

• Family benefits such as adoption assistance and paid parental leave.

• Defined contribution retirement plans with employer match and other financial wellness programs.

• Educational Assistance Program.